vasculitis

Figure A shows a normal artery with normal blood
flow (the inset image shows a cross-section of the normal artery).
Figure B shows an artery narrowed due to inflammation
in the arterial wall, causing decreased blood flow (the inset image
shows a cross-section of the inflamed artery). Figure C shows a totally
occluded (blocked) artery due to inflammation and scarring in the
arterial wall (the inset image shows a cross-section of the block
artery). Figure D shows an artery containing an aneurysm.

An inflammation of the blood vessels
in the body. In vasculitis, the body's immune
system mistakenly attacks the body's own blood vessels, causing them
to become inflamed. Inflammation can damage the blood vessels and lead to
a number of serious complications.

Vasculitis can affect any of the body's blood vessels. These include arteries,
veins, and capillaries.
Arteries are vessels that carry blood from the heart
to the body's organs, veins are the vessels that carry blood back to the
heart, and capillaries are the tiny blood vessels that connect the small
arteries and veins.

When a blood vessel becomes inflamed, it can:

Narrow, making it more difficult for blood to get through

Close off completely so that blood can't get through at all (occlusion)

In rare cases, stretch and weaken so much that it bulges (aneurysm)
and may possibly burst (aneurysm rupture)

The disruption in blood flow from inflammation can damage the body's organs.
Specific signs and symptoms depend on which organ has been damaged and the
extent of the damage. Typical signs and symptoms of inflammation (fever,
swelling, and a general sense of feeling ill) are common among people with
vasculitis.

Outlook

The outlook for people who have vasculitis varies depending on both the
type and severity of the vasculitis. The course of a case of vasculitis
can be hard to predict. Treatment is often very effective if vasculitis
is diagnosed and treated early. Vasculitis may disappear or go into a period
of remission. In some cases, it may be a chronic problem, requiring ongoing
treatment, or it may come back ("flare") after a period of remission.
In more severe cases, treatment may not help, and vasculitis can lead to
disability or even death.

Much is still unknown about vasculitis. There are many different types of
vasculitis, but overall it is a fairly rare condition in the general population.
Additional research is needed to learn more about the various types of vasculitis
and their causes, treatments, and remission patterns.

Types of vasculitis

There are many different disorders that are classified as types of vasculitis.
Although all of these disorders include inflammation of the blood vessels,
most differ from each other in terms of what populations of people and which
organs they affect.

Behcet's disease

Behcet's disease can affect any part of the body because it can occur in
vessels of any size or type. Commonly affected organs include the eyes,
the mouth, and the genitals. Patients with this type of vasculitis are often
younger than those with other types, many times in their twenties and thirties.
The HLA-B51 gene allele is often associated
with Behcet's disease, but not everyone with the gene will develop the disease.
Behcet's is more common in individuals of Mediterranean, Middle Eastern,
or Far Eastern descent, but is usually not found in Blacks.

Buerger's disease

Buerger's disease typically affects blood flow to the hands and feet. Buerger's
disease is also known as thromboangiitis obliterans and is more likely to
occur in smokers than nonsmokers.

Central nervous system
vasculitis

Central nervous system vasculitis affects the brain
and sometimes the spinal cord.

Churg-Strauss syndrome

Churg-Strauss syndrome can affect many different organs, but it most commonly
affects the lungs, skin,
kidneys, and heart. Many people who are diagnosed
with Churg-Strauss syndrome also have asthma.
They may have had preexisting, newly diagnosed, or recently worsened asthma
when diagnosed with Churg-Strauss syndrome.

Cryoglobulinemia

Common signs and symptoms of cryoglobulinemia are a rash on the lower limbs,
arthritis, and nerve damage. Type 1 cryoglobulinemia
is often associated with lymphoma, while Type 2 cryoglobulinemia is often
associated with hepatitis C infection.

Giant cell arteritis

Common symptoms of giant cell arteritis include headache,
fever, blurred vision, and pain in the jaw, shoulders, or hips. It is the
most common form of vasculitis that occurs in adults older than 50 years.
It is more likely to occur in people of Scandinavian origin, but can occur
in people of any race.

Henoch-Schonlein purpura

Henoch-Schonlein purpura most commonly affects the skin, kidneys, joints,
and stomach. It is the most common form
of vasculitis found in children, but can occur at any age. When seen in
children, it often follows an upper respiratory infection. It is not usually
a chronic disease, and full recovery is common.

Microscopic
polyangiitis

Microscopic polyangiitis most commonly affects the kidneys, skin, and nerves,
but it can affect any organ in the body.

Polyarteritis
nodosa

Polyarteritis nodosa most commonly affects the kidneys, skin, and nerves,
but it can affect any organ in the body. It is most common in people in
their thirties and forties. Men are twice as likely as women to get polyarteritis
nodosa. In some cases, it is associated with chronic hepatitis B infection
or a very specific type of leukemia known
as hairy cell leukemia.

Polymyalgia rheumatica

Polymyalgia rheumatica most commonly affects the large joints in the body,
such as the shoulders and hips.
It often occurs along with giant cell arteritis.

Rheumatoid
vasculitis

Rheumatoid vasculitis can affect many different organs, including the eyes,
skin, hands, and feet. It commonly occurs in patients who have severe rheumatoid
arthritis.

Takayasu's arteritis

Takayasu arteritis affects the aorta (the
largest blood vessel in the body) and its branches, which carry blood away
from the heart. It typically occurs in Asian women younger than 40.

Wegener's granulomatosis

Wegener's granulomatosis can occur anywhere in the body. It most commonly
affects the upper respiratory tract (nose, sinuses, and throat), lungs,
and kidneys. It is most common in people who are middle-aged and older.

What causes vasculitis?

Vasculitis is an inflammation of the blood vessels, but what causes the
inflammation is often unknown. It is sometimes a side effect of the body's
immune system response to a recent or chronic infection. It also can be
a side effect of the body's response to a medicine. The body sometimes recognizes
a medicine as a foreign substance, and may develop an "allergic reaction"
to try to get rid of it.

Vasculitis is sometimes linked to other diseases, such as:

Autoimmune system diseases.
These are diseases that the vasculitis patient may have had for years,
in which the body's immune system mistakenly attacks the body itself.
Examples include systemic lupus erythematosus (lupus), rheumatoid arthritis,
and scleroderma.

Blood cancers. These include leukemia and lymphoma.

Who is at risk for vasculitis?

Vasculitis can affect anyone, including men, women, and people of all ages.
Some types of vasculitis are more likely to affect certain populations than
others. Examples of populations that might be more affected by certain types
of vasculitis include smokers, children, young women, middle-aged adults,
and people with chronic hepatitis B and/or C infections.

What are the signs and symptoms of vasculitis?

Vasculitis can have many different signs and symptoms depending on the type
of vasculitis and which organs are involved as well as how severely they
are affected. With vasculitis, any number of organs may be involved, so
a patient can experience very few signs and symptoms or may be very sick.

There are two types of signs and symptoms that are common among people with
vasculitis: those that affect the body in a general way (systemic) and those
that affect specific organs or body systems.

Systemic

Systemic signs and symptoms are not specific to a particular part of the
body, but affect a person overall, causing general aches, pains, and sickness.
Common systemic symptoms include:

Fever

Loss of appetite

Weight loss

Fatigue (feeling tired) and weakness

General aches and pains

Organ- or body system-specific

These signs and symptoms are specific to a particular organ or body system.
The organs and body systems that can be affected include:

Skin. People may experience a variety of skin changes, including
purple or red spots. The changes may look like clusters of small dots,
splotches, bruises, or hives. They may
be itchy or painless.

Joints. People can experience aches and arthritis if the joints
are affected.

Lungs. People may experience shortness of breath or even cough
up blood. On a chest X-ray, lung symptoms may look like pneumonia,
even though they are not.

Gastrointestinal tract. Ulcers in the mouth may be present
in some types of vasculitis. Also, abdominal pain or bloody diarrhea
can occur in people with vasculitis. In some severe cases, the intestines
can rupture.

Sinuses, nose, and ears. People may experience sinus
infections, chronic middle ear infections, ulcers in the nose, or in
certain cases there may be hearing loss.

Eyes. People whose eyes are affected by vasculitis may experience
a blurring or loss of vision.

Brain. People may experience headaches, confusion, changes
in behavior, or strokes.

Nerves. People may experience numbness, tingling, and weakness
in various parts of the body. They also may experience symptoms in their
limbs, such as loss of feeling or strength in the hands and feet or
shooting pains in the arms and legs.

How is vasculitis diagnosed?

The diagnosis of vasculitis is based on a person's medical history, physical
exam, signs and symptoms, and laboratory tests.

Specialists
involved

A person with vasculitis may be referred to various specialists, including:

A dermatologist (skin specialist)

A hematologist (blood specialist)

A pulmonologist (lung specialist)

A cardiologist (heart specialist)

A neurologist (nervous system specialist)

An ophthalmologist (eye specialist)

A urologist (urinary tract and urogenital system specialist)

A nephrologist (kidney specialist)

An infectious disease specialist

Diagnostic tests and procedures

A variety of tests are used to diagnose vasculitis. The type of test chosen
will depend on the signs and symptoms a person has. Some of the tests used
in the diagnosis of vasculitis include:

Blood tests. These may be done to look for abnormal levels of blood
cells or antibodies, which could be a sign of inflammation in the body.

Biopsy. During this test, the doctor
takes a small sample of tissue from a blood vessel or one of the affected
organs and looks at it under a microscope for inflammation or damage.
A biopsy is often the best way to make a firm diagnosis of vasculitis.

Urine analysis. This test might be done to look for abnormal levels
of protein or blood cells in the urine, which could be a sign of vasculitis
affecting the kidneys.

EKG (electrocardiogram).
This test measures the rate and regularity of the heartbeat, and is
done to see if vasculitis is affecting the heart.

Echocardiogram. This test uses
sound waves to create a moving picture of your heart. Echocardiogram
provides information about the size and shape of your heart and how
well your heart chambers and valves are functioning. The test also can
identify areas of poor blood flow to the heart, areas of heart muscle
that are not contracting normally, and previous injury to the heart
muscle caused by poor blood flow.

Chest X-ray. A chest X-ray takes
a picture of the organs and structures inside the chest, including the
heart, lungs, and blood vessels. A chest X-ray may show abnormal changes
if vasculitis is affecting the lungs.

Pulmonary function testing. These are breathing tests that evaluate
how well the lungs are working. These tests are done to see if vasculitis
is affecting how the lungs work.

Abdominal ultrasound.
This test uses sound waves to create a picture to look for vasculitis
affecting the abdominal organs. It is similar to an echocardiogram.

Computerized tomography
(CT) scan. A CT scan provides a computer generated x-ray image of
the internal organs. CT scans can be used to look for vasculitis affecting
the abdominal organs or the brain.

Angiography. This test may be
done to see the flow of blood through the blood vessels and to determine
whether they are blocked. During this test, a dye is injected into the
blood vessels, and X-ray pictures of the blood vessels are taken.

How is vasculitis treated?

Most cases of vasculitis are treated with prescription medicines.

Goals of treatment

The main goal of treatment is to stop the inflammation in the affected blood
vessels. Most treatments do this by stopping the immune or inflammatory
response that caused the vasculitis to occur.

Specific
types of treatment

There are two types of prescription medicines that are typically used to
treat vasculitis: corticosteroid medicines and cytotoxic medicines.

Corticosteroid medicines

Corticosteroid medicines are often
called steroids, though these are not the same kind of steroids that athletes
have been reported to use. These medicines are used to reduce the inflammation
in the blood vessels. Examples of corticosteroids that the doctor might
prescribe include prednisone, prednisolone,
and methylprednisolone.

Cytotoxic medicines

Cytotoxic medicines are typically used to treat cancer, but certain drugs
also can be used to treat vasculitis. They may be prescribed in severe cases
or in cases in which the patient did not respond to corticosteroids. Sometimes,
they are prescribed along with corticosteroids. Cytotoxic medicines work
by killing the cells that have caused the inflammation. Examples of these
medicines include azathioprine and cyclophosphamide. Doses used for vasculitis
are usually lower than those used to treat cancer.

How can vasculitis be prevented?

There is currently no known way to prevent vasculitis, but with treatment,
the complications of vasculitis can be prevented or delayed.

Living with vasculitis

General information about outcomes

The course of vasculitis is unpredictable and depends on the type and severity
of the disease. Vasculitis may:

Go into remission. If caught early it may respond well to treatment
and go into remission.

Reoccur. These reoccurrences are called flares, and they are generally
difficult to predict. Flares can sometimes happen when the doctor takes
the patient off of a medicine or alters the dose or type. Also, certain
types of vasculitis are more likely to flare than others, and some patients
are more likely to experience flares than others.

Remain chronic without remission. In these cases, vasculitis can usually
be controlled with continuing medicine treatments for an extended period
of time.

Not respond well to treatment. This can lead to disability or even
death. This is rare.

Ongoing health care needs

The medicines used to treat vasculitis can have significant side effects.
Your doctor may adjust the type or dose of medicine you take to lessen the
side effects.

In cases in which remission occurs, the doctor may carefully withdraw medicines
but still require careful monitoring of flares. Patients who continue taking
medicines should stay under the careful watch of their doctor to monitor
and control side effects. Patients also should always monitor their health,
side effects, and symptoms and discuss any changes with their doctor.